• A decrease in nurses’ walking time and trips to obtain supplies. These and other efficiencies significantly increased available nursing time and permitted a reduction in budgeted staff care hours while increasing direct patient care time.

  • A decrease in patient dissatisfaction.

The Cardiac Comprehensive Critical Care Unit has been recognized by the American Association of Critical Care Nurses/Society for Critical Care Medicine/American Institute of Architects as “best design in a critical care nursing unit” (Hendrich et al., 2004).

Potential workspace design elements for safety Workspace design initiatives, such as that of Methodist Hospital and those undertaken by the Pebble Project, aim to improve efficiency, safety, and overall patient and workforce experiences in care delivery. Several workspace design elements (shown in Table 6-2) based on LEAN operation and other work design principles can potentially achieve workload reductions and more efficient and safer care delivery in general patient care rooms (Hendrich and Lee, 2003c; Ulrich, 1991). Similar concepts apply to the design of adult critical care units (Hamilton, 1999) although there are special considerations for neonatal intensive care units (Graven, 1997). The committee notes that little research has been conducted establishing the efficiency and effectiveness of these measures in improving patient safety. However, the committee also notes the evidence in support of their use as LEAN practices, as well as their beneficial effect on patients, and strongly urges further implementation and evaluation of these interventions.

Getting started in work redesign Some of the principles and methods of work design are relatively intuitive and easy to apply. Many HCOs already practice root-cause analysis; others have used work sampling and failure modes and effects analysis to redesign work. Work redesign is sometimes undertaken using quality improvement approaches such as the plan-do-check-act cycle (Carayon et al., 2003). Many of the documentation redesign initiatives described earlier were undertaken by interdisciplinary teams without the use of professional experts in work redesign. Other HCOs, including small community hospitals, have reported the use of internal work teams composed of existing staff to redesign work processes (Doerge and Hagenow, 1995; Fletcher, 1997). However, work design initiatives can be enhanced when individuals with knowledge of different disciplines, such as environmental design, human factors, and industrial relations, are involved. Sometimes this specialized knowledge can be supplied only by experts in work design with these areas of expertise.

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